Achalasia Overview by Digestive Disease Institute

Achalasia is a condition in which the esophageal muscle lacks the ability to move food into the stomach. The lower esophageal sphincter (LES), located between the esophagus and stomach, stays closed, resulting in the back up of food. Other symptoms include vomiting undigested food, chest pain, heartburn and weight loss.

Diagnosis

Three tests are most commonly used to diagnose and evaluate a swallowing problem:

Barium swallow. The patient swallows a barium preparation (liquid or other form) and its movement through the esophagus is evaluated using X-ray technology.

Endoscopy. A flexible, narrow tube called an endoscope is passed into the esophagus and projects images of the inside onto a screen.

Manometry. This test measures the timing and strength of esophageal contractions and muscular valve relaxations.

Treatment

If left untreated, achalasia can be debilitating. People experience considerable weight loss that can result in malnutrition. Lung infections and pneumonia due to aspiration of food can result, particularly in the elderly. Although the exact cause of achalasia is unknown, researchers think it may be linked to a virus.

Balloon dilation

Most often, achalasia can be successfully treated non-surgically with balloon (pneumatic) dilation. While the patient is under light sedation, the gastroenterologist inserts a specifically designed balloon through the LES and inflates it. The procedure acts to relax and open the muscle.

Some patients may have to undergo several dilation treatments in order to achieve symptom improvement, and the treatment may have to be repeated every few years to ensure long-term results. Up to two-third of patients are treated successfully with balloon dilation.

Medication

Other patients, particularly those who are not appropriate candidates for balloon dilation or surgery, benefit from Botox® injections. Botox is a protein made by the bacteria that cause botulism. When injected into muscles in very small quantities, it can relax spastic muscles. It works by preventing nerves from sending signals to the muscles that tell them to contract. A smaller percentage of patients (up to 35 percent) achieve good results using Botox compared to balloon dilation. In addition, the injections must be repeated frequently in order to achieve symptom relief.

Other medications, such as nifedipine and nitroglycerin, may help to relax spastic muscles. Patients who take nifedipine every day may experience satisfactory results for a couple of years.

Minimally Invasive Surgery

For select patients with severe achalasia, a minimally invasive surgical technique called laparoscopic esophagomyotomy or the Heller Myotomy may help.

Like all minimally invasive surgery, surgeons use a thin, telescopic-like instrument called an endoscope, which is inserted through a small incision. The endoscope is connected to a tiny video camera-smaller than a dime-that projects a view of the operative site onto video monitors located in the operating room. Minimally invasive surgery techniques offer patients a shorter hospital stay, quicker recovery and less scarring than traditional procedures.

Up to two-third of patients are treated successfully with surgery, though some patients may have to repeat the surgery or undergo balloon dilation to achieve satisfactory long-term results.

Although achalasia is relatively rare, Cleveland Clinic treats approximately two cases every week. Over the last seven years, the Cleveland Clinic Digestive Disease Institute has treated more patients with achalasia than any other center in the United States – and probably the world. The Digestive Disease Institute also is one of the few centers in the world diligently researching the cause of, and treatment for achalasia.